The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis

Abstract

The purpose of this systematic review was to identify the operative issues and specific dysmenorrhea and menorrhagia outcomes in women who had undergone fertility-sparing surgery, as well as determine the expected outcome for extirpative surgery. Data Sources: PROSPERO (ID no. 125692). Search was conducted for eligible studies up to March 31, 2019, on MED-LINE/PubMed (1966, Scopus/Elsevier (1950), and Google Scholar (up to 2019. The search terms applied for the search strategy were as follows: adenomyosis, adenomyomas, uterus-sparing surgery, fertility-sparing surgery, pain, dysmenorrhea, menorrhagia, uterine volume, adenomyotic volume, case-control studies, cohort studies, and prospective studies. Methods of Study Selection: A total of 443 studies were initially identified. Exclusion criteria was as follows: (1) inadequate description of preoperative adenomyosis or absence of postoperative histology confirmation of adenomyosis, (2) no statement of use of a standardized instrument for measurement of pain, bleeding, or adenomyotic/uterine volume, (3) follow-up <12 months postoperatively, (4) study population <20 women, and (5) non-English language. Tabulation, Integration, and Results: Nineteen studies with a total of 1843 patients with adenomyosis were included. Twelve studies were further analyzed in the meta-analysis. Complete excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 6.2, 3.9, and 2.3, respectively; the partial excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 5.9, 3.0, and 2.9, respectively; the studies with a mixed volume of patients with complete and partial excision of adenomyosis reported improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 4.0, 6.3, and 5.1, respectively. Conclusion: The surgical treatment of adenomyosis results in the satisfactory control of pain and bleeding, as well as in the reduction of uterine volume. Further research is warranted to investigate the long-term control of symptoms to identify any parameters related to the recurrence of adenomyosis, as well as to compare the conservative surgical treatment of adenomyosis with other treatment options.

Robot-assisted laparoscopic adenomyomectomy: A review of literature

“…The majority of pregnancies continue to proceed to a vi-able term delivery. The elected method of delivery is cesarean section, although there are cases of uncomplicated vaginal births [12].…”

“…Pain and bleeding were both improved by more than 70% at 12 months. Complete excision of adenomyosis resulted in better improvement of pain, menorrhagia, and reduction of uterine volume, yet even after partial excision the improvements were substantial [12].…”

Current and Future Surgical and Interventional Management Options for Adenomyosis

“…4 A recent metaanalysis of 12 studies reported that out of 364 women following partial and complete excision of adenomyosis, 35% successfully conceived and of those, 74% delivered at full term with a lower than previously reported uterine rupture rate of 0.8%. 18 Many authors favor prelabor cesarean delivery due to this risk, 19 though successful vaginal deliveries have been reported.…”

Аналіз Клініко-Анамнестичних Даних І Преморбідного Фону При Аденоміозі

“…Частота безпліддя у хворих на ендометріоз коливається від 25 до 60 % [1,22,23,28]. За нашими даними, безпліддя було виявлено у 61 (46,9 %) хворої на аденоміоз, причому в 14 (22,9 %) -первинне, а в 15 (24,5 %)…”